Eyeworld

45 EW FEATURE July 2016 • Refractive surgery in military personnel and first responders surgery while in service varies depending on the branch and his or her occupation, Dr. Reilly said, adding that while it might require "some administrative hoops," the procedure is very popular. Dr. Reilly, who was also chair of the Depart- ment of Ophthalmology at the Wilford Hall Air Force Center and consultant to the Air Force Surgeon General for Refractive Surgery, em- phasized that an active-duty patient must have his or her commander's approval prior to surgery. Refractive surgery in the mili- tary was a paradigm shift. "Military medicine has always been predicated on the principle that you take injured soldiers, sailors, airmen, and make them better, return them to health," Dr. Schallhorn said. "Refractive surgery takes healthy individuals and helps them do their jobs better with a significant safety benefit—and as a byproduct, there's a huge quality of life benefit, too." In addition, refractive surgery has eliminated many of the barriers that prevented men and women from assuming certain occupations in the Navy, Air Force, and Army, provided they are good candidates for the corrective surgery in the first place. "There are no restrictions now," Dr. Schallhorn said. "It used to be that 70% of all people who could not be a Navy pilot were rejected because of myopia in the past—now that's gone." EW References 1. Schallhorn SC, et al. Preliminary results of photorefractive keratectomy in active-duty United States Navy personnel. Ophthalmology. 1996;103:5–22. 2. Stanley PF, et al. Laser refractive surgery in the United States Navy. Curr Opin Ophthalmol. 2008;19:321–324. Editors' note: Drs. Schallhorn, Reilly, and Butler have no financial interests related to their comments. The views expressed by the sources of this article are their own, not those of the Department of Defense. Contact information Butler: fkb064@yahoo.com Reilly: cdreillymd@gmail.com Schallhorn: scschallhorn@yahoo.com an excimer laser for the procedure on active-duty U.S. Navy person- nel. 1 The research published in Ophthalmology in 1996 found that PRK reduced myopia and improved visual acuity in all 30 patients who were followed for 12 months postop. The FDA approved PRK to correct myopia in 1995. Following this study, Dr. Schallhorn said the Navy purchased its first laser and began to conduct many other studies looking at a host of issues such as visual recovery, quality of vision, extreme environ- mental conditions, and the impact of PRK on marksmanship ability. Dr. Schallhorn said there were 2 studies pivotal in changing poli- cies for refractive surgery for Naval aviators, called the "Retention" and "Accessioning" projects. Accord- ing to a paper published in Current Opinion in Ophthalmology in 2008 discussing this research, the "Reten- tion of Naval Aviators PRK Study," there were 785 aviators who had received PRK and 90% were able to fly without vision correction 6 weeks postop. 2 What's more, 87% reported experiencing better vision for carrier landings after the surgery. "PRK was able to return all of the treated aviators to the highest vi- sual classification for a Naval aviator, and there were more than 47,051 flight hours accumulated and 2,979 aircraft carrier landings by PRK-treat- ed aviators," the authors of this paper wrote. The "Accessioning" study was designed to determine any issues that post-PRK patients entering flight training might experience. More than 300 post-PRK students were admitted to flight training and were compared to more than 5,000 controls. "In no case did the PRK students perform worse than controls," the authors wrote. "This was the first study that enabled a myope, who since the in- ception of Naval aviation could nev- er have been a carrier pilot, to now enter flight training in the Navy. That was the study that allowed peo- ple who always knew they couldn't be a Navy pilot to do so if they had a successful PRK procedure," Dr. Schallhorn said. Not only did these studies lead to monumental change in the mil- itary, but they then led to changes for first responders and others in visually demanding, dynamic jobs as well. As LASIK came onto the scene, many military studies were conducted, including the evaluation of LASIK flap stability, improved ablation profiles, and the use of femtosecond lasers. These even- tually led to the procedure being approved for U.S. military personnel as well. Still, Dr. Schallhorn said the majority of refractive procedures performed on military personnel today are PRK. This is due to the long history of successful surface ablation procedures making it a preferred procedure for surgeons and patients. However, he thinks that as the military continues to research newer technologies it will serve to improve options and outcomes for service men and women. Refractive surgery changed the military It is life-saving and performance enhancing. These are the 2 bene- fits a Navy admiral cited when he told Dr. Schallhorn that he would accept the risk of PRK presented to him, leading to his approval of the surgery for SEALs. Time and further research would lead other branches of the military to accept it for various roles as well. At this point, the standard for military members to enter as a post-refractive patient or receive David Tanzer, MD, then a captain in the U.S. Navy and director of the refractive surgery program at the Naval Medical Center, performs PRK in 2010. Source: U.S. Navy/Mass Communication Specialist 2nd Class Chad Bascom

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